Implementation of cognitive reappraisal in subthreshold psychosis

Cognitive reappraisal is an emotion regulation strategy based in cognitive behavioral therapy and can be associated with positive outcomes for individuals with and at risk for psychosis. However, the literature is mixed regarding whether this population uses cognitive reappraisal effectively. The current study examined cognitive reappraisal effectiveness in individuals at clinical high risk for psychosis and healthy control participants (N = 66; 34 clinical high risk, 32 healthy controls). The experimental task instructed participants to engage in reappraisal in real-time to regulate distress. We hypothesized that control participants would be more effective at using cognitive reappraisal compared to psychosis-risk participants, resulting in greater distress reduction post-reappraisal. Results demonstrated the opposite: the psychosis-risk group reported a greater change in distress level than the healthy control group after reappraisal was employed (Cohen’s d = 0.52). Exploratory analyses revealed that the clinical high risk group reported higher pre-task distress, but reported post-reappraisal distress levels equivalent to the healthy control group. These results contribute to emerging evidence that suggests individuals on the psychosis spectrum can implement reappraisal effectively. Therefore, complex training to improve cognitive reappraisal may not be needed. Instead, future research should examine the potential clinical utility of using simple reminders and/or guided prompts to promote cognitive reappraisal in individuals on the psychosis spectrum.